Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Heart failure (HF) is a debilitating chronic illness that afflicts millions of Americans and carries a poor prognosis, likely due to insufficient medication and low-salt diet adherence, which exacerbates HF symptoms and leads to frequent rehospitalizations. Specific reasons underlying non-adherence among HF patients are unclear. Studies investigating reasons for adherence among HF patients have shown that correlates of poor adherence include demographic (i.e., age, income), functional (i.e., NYHA), and psychosocial (i.e., social support, depression) variables. Research studies among individuals with chronic diseases suggest that an individual’s beliefs about medicines may explain adherence, but this research is limited among HF patients. The purpose of this study was to examine how psychosocial variables and beliefs about medicines are related to self-reported medication and low-salt diet adherence among individuals with HF, while controlling for demographic and physical functioning variables. This study had three aims: 1) To examine the relationships between psychosocial variables (e.g., depression, hostility, social support) and adherence; 2) To examine the relationship between beliefs about medicines and adherence; and 3) To investigate whether beliefs about medicines moderate the relationship between psychosocial variables and adherence. An ethnically-diverse sample of 105 HF patients completed several measures assessing depressive symptoms, level of hostility, perceived social support, beliefs about medicines, and medication and low-salt diet adherence. Structural equation modeling revealed that higher depression, higher hostility, and a stronger belief that medications are harmful and/or overused by doctors were significantly related to worse medication adherence. Further, participants who believed that medicines are necessary and had few concerns about them were more likely to adhere to a low-salt diet. Age, income, and number of co-morbid illness also were significantly related to low-salt diet adherence beyond contributions of beliefs about medicines scales and psychosocial variables. Thus, overall it appears that different beliefs about medicines differentially influence medication versus low-salt diet adherence, and psychological disposition may not underlie low-salt diet adherence. These results can inform interventions of health care practitioners in addressing adherence issues with HF patients.

Inflammatory bowel disease (IBD; Crohn’s disease & ulcerative colitis) is a chronic illness in which medication and dietary adherence may determine disease natural history and severity of symptoms. We hypothesized that age, prospective memory (PM) and body satisfaction would predict medication and dietary adherence in adolescents with IBD and that gender and age would modify the relation between body satisfaction and adherence, with older girls being less adherent than younger children. Fifty-seven participants aged 10-21 (M = 16.5, SD = 2.3) with IBD and their caregivers were recruited. Informed consent, demographics and body satisfaction questionnaires were completed. PM was assessed using a naturalistic task. Adherence was measured by the 1-week completion of a medication and dietary log. A questionnaire was administered to evaluate coping strategies used for overcoming obstacles to dietary adherence. Two hierarchical regressions were conducted for medication and diet adherence respectively. As hypothesized, age had a significant effect (â = -.42, p < .01) on dietary adherence, accounting for approximately 17% of the variance (R2change = .17; Fchange (1,41) = 8.57, p = .006), with younger children being more adherent. Body satisfaction had a greater and more significant effect on dietary adherence than age (â = -.33, p < .01); i.e. participants more satisfied with their body reported better dietary adherence (R2change = .28; Fchange (2,35) = 6.97, p < .05). Findings remained consistent across multiple measures of body satisfaction and dietary adherence. None of the predictors had a significant effect on medication adherence. Health care providers who treat adolescents with IBD and parents should be made aware of factors affecting adherence in order to improve disease outcomes and patients’ quality of life.

No description available.

Il est actuellement bien établi que les facteurs nutritionnels sont les principaux déterminants de l’émergence des maladies chroniques. Au Maroc, il n’existe pas à ce jour de données étayant ces propos, bien que ce pays soit en pleine transition épidémiologique. L’objectif de la thèse était d’étudier la relation entre les facteurs nutritionnels et l’obésité ou surpoids chez un échantillon représentatif des adultes marocains âgés de 18 ans et plus obtenu par tirage au sort et stratification sur le sexe et l’origine. Au total, 2896 sujets ont participé à cette enquête transversale. L’obésité et le surpoids étaient très fréquents (13,5% et 29,9% respectivement) avec de grandes disparités socioéconomiques. Pour mieux décrire le comportement alimentaire des marocains, très probablement en rapport avec l’émergence de ce phénomène, plusieurs approches complémentaires ont été utilisées. D’abord, l’adhérence au régime de type méditerranéen, a été mesurée par un score construit selon une approche confirmatoire. Puis, l’identification des principaux profils de consommation spontanément observés par des méthodes exploratoires (analyse en composantes principales). Il s’avère que le régime méditerranéen n’était pas le régime communément suivi par toute la population marocaine. De plus, quatre principaux profils étaient identifiés et décrivent mieux le phénomène de transition nutritionnelle dont la spécificité au Maroc est le maintien de certains aliments traditionnels tels les céréales et légumes en plus de l’introduction des aliments occidentalisées tels les produits laitiers. Ces profils étaient associés aux caractéristiques sociodémographiques des individus. Une association significative a été notée entre l’obésité et les profils alimentaires occidentalisés mais pas avec le régime méditerranéen qui était, par ailleurs, associé au surpoids. / It is now well established that nutritional factors are the main determinants of the emergence of chronic diseases. In Morocco, there is currently no data to support this evidence, although this country is experiencing an epidemiological transition. The aim of the thesis was to study the relationship between nutritional factors and overweight or obesity in a representative sample of Moroccan adults aged 18 years and above. This sample was obtained by a simple random technique after stratification by sex and origin. In total, 2896 subjects have participated in this cross-sectional survey. Obesity and overweight were very frequent (13.5% and 29.9% respectively) with large socioeconomic disparities. To better describe the behavior of Moroccan food, most likely related to the emergence of this phenomenon, several complementary approaches were used. First, adherence to Mediterranean diet was measured by a score constructed using a confirmatory approach. Then, the identification of major patterns of consumption observed spontaneously by exploratory methods (Principal Component Analysis). Mediterranean diet was not the commonly diet followed by the entire Moroccan population. In addition, four major patterns were identified and describe better the nutritional transition in Morocco whose specificity is the maintenance of some traditional foods such as cereals and vegetables with some Westernized foods newly introduced such as dairy products. These profiles were associated with sociodemographic characteristics of individuals. A significant association was found between obesity and westernized dietary patterns but not with the Mediterranean diet which was associated with overweight.